Case 159

1. Presented by Ahmad Kohsar, DO, MS and reviewed by Lorraine Blagg, MA, MLS(ASCP)CMSBB, AHI(AMT)

A patient with an unknown medical history was found obtunded and unresponsive and was admitted to the ICU. They were found to be anemic with a hemoglobin of 6.5 g/dL. They were transfused a unit of RBCs. During the transfusion of the red cells, they spiked to a temperature up to 38.9°C from a baseline of 37.5°C. Additionally, they had persistent hypoxia with O2 saturation in the high 80s, requiring supplemental oxygen. Recent imaging just before transfusion shows a unilateral consolidation possibly from aspiration, and they appeared euvolemic with normal pressures and normal BNP. The results of the transfusion reaction workup are as follows:

Blood Bank HistoryPatient ABO/Rh: A POS
Antibody Detection: Negative
Requirements: Leukoreduced RBCs
Transfused RBCs: A POS

Blood Product RequisitionDemographic information matched
Special Requirements: Leukoreduced
Patient Location: ICU

Patient’s ABO/Rh: A POS
Blood Component Type: RBCs
Blood Component ABO/Rh: A POS
The blood component is crossmatch-compatible

Patient Plasma Hemolysis Check: Negative
Observation of Transfusion Line for Hemolysis: Negative

Blood Component ABO/Rh:
Anti -AAnti-BAnti-D
4+04+
Pre-Sample DAT:
Polyspecific IAT (Anti-IgG and Anti-C3)Check Cells
02+
Pre-Sample ABO/Rh:Front Type:
Anti -AAnti-BAnti-DMonoclonal Control
4+04+0
Reverse Type:
A1 cellsB cells
04+
Pre-Sample Antibody Detection: LISS
37 CIATCC
Screening Cell I002+
Screening Cell II002+
37: Incubation at 37C
IAT: Indirect Globulin Test (Anti-IgG)
CC: Check Cells

Pre-Sample Crossmatch: LISS
RBCs37CIATCC
Transfused Unit002+
Post-Sample DAT:
Polyspecific IAT (Anti-IgG and Anti-C3)Check Cells
02+
Post-Sample ABO/Rh:Front Type:
Anti -AAnti-BAnti-DMonoclonal Control
4+04+0
Reverse Type:
A1 cellsB cells
04+
Post-Sample Antibody Detection: LISS
 37 CIATCC
Screening Cell I002+
Screening Cell II002+
Post-Sample Crossmatch: LISS
RBCs37CIATCC
Transfused Unit002+
Preliminary gram stain and cultures have been negative to date.

Question: What is the most likely cause of these findings?